“We have a palliative care subject”, Emmanuel Macron told journalists from the Presidential Press Association on September 12, 2022. It was on the eve of the launch of the national debate on the end of life. By opening the way to a possible legalization of assisted suicide or euthanasia, the Head of State found himself obliged to carry out another project: the development of access to palliative care, capable of relieving the pain and psychic suffering of people in the last moments of their existence. A right recognized since 1999, but which implies that the government removes many obstacles to be more widely applied.
Agnès Firmin Le Bodo was responsible for lifting these brakes. “Reflections on the interest of defining a ten-year strategy are underway”, is content to affirm the office of the minister delegate in charge of territorial organization and the health professions. The first measures should be announced in June, when the deputies will discover the tracks of reform of the Court of Auditors in a report which they requested, on palliative care.
Financial magistrates have just received a little blue booklet from the French Society for Support and Palliative Care (SFAP). Also given to M.me Firmin Le Bodo, sent Friday February 10 to François Braun, Minister of Health, it includes the “six proposals that seem to us to be priorities”says its president, Dr. Claire Fourcade.
An illegible range of solutions
The executive and health professionals have a common objective: to first improve palliative care at home, where the unmet needs are the greatest and where organizational difficulties multiply.
Thus, it is when they live at home that people at the end of life are most penalized by the lack of general practitioners. Fewer and fewer, they often decline visits to the bedside of the dying.
Encouraging general practitioners to monitor end-of-life patients presupposes more incentive fees. Today, they cannot charge more than four visits per year and per patient in palliative care, paid at 70 euros, instead of 35 euros, the basic rate at home. The National Health Insurance Fund is studying, at the request of the ministry, the abolition of this quota.
To make up for the lack of self-employed doctors, mobile palliative care teams made up of doctors and caregivers should see their role and mission strengthened. They, who mainly work in hospitals, will be called upon more to intervene at home and in nursing homes. While they did not have the right to prescribe treatments, they might be authorized to do so, according to Doctor Olivier Mermet, kingpin of the measures in preparation at the ministry as co-author of the fifth national plan on palliative care (2021- 2024).
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